Jung JJ, et al. – Researchers tried to find out whether asymptomatic PEH should receive elective laparoscopic hernia repair (ELHR) or watchful waiting (WW). The results of this study displayed that patients with asymptomatic paraesophageal hernia (PEH) are more likely to achieve greater health outcomes if they undergo WW as initial treatment than ELHR.

Methods

• In this research, a Markov Monte Carlo microsimulation decision analysis model followed a hypothetical cohort of asymptomatic PEH patients who have predominantly female gender and normally distributed mean age of 62.5 years for the lifetime.
• They compared accrued health benefits expressed in quality–adjusted life months (QALM) between two strategies: WW and ELHR.
• They conducted two–dimensional simulations to account for uncertainties in the model.
• They performed deterministic sensitivity analyses to test key assumptions.

Results

• The data showed that WW was the superior strategy in 82% of the simulations, accumulating mean 5 QALM more than ELHR (168 vs. 163) after considering both individual– and parameter–level uncertainties in the two–dimensional simulations.
• This model was robust to deterministic sensitivity analyses and was internally validated, which supported the validity of the outcomes.